Method for diagnosing an increased risk of preeclampsia by measuring the level of HIF-α

ABSTRACT

Methods are provided for the diagnosis and treatment of patients with increased risk of preeclampsia. The methods involve measuring levels of TGF-β 3 , receptors of cytokines of the TGβ family, or HIF-1α.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No. 12/252,400, filed Oct. 16, 2008, now U.S. Pat. No. 7,754,495, which is a continuation of U.S. patent application Ser. No. 11/043,493, filed Jan. 26, 2005, now U.S. Pat. No. 7,445,940, which is a continuation of U.S. patent application Ser. No. 10/028,158, filed Dec. 20, 2001, now U.S. Pat. No. 6,863,880, which is a division of U.S. patent application Ser. No. 09/380,662, filed Dec. 21, 1999, now U.S. Pat. No. 6,376,199, which is a National Stage of PCT/CA98/00180, filed Mar. 5, 1998, which claims the benefit of the priority of U.S. Provisional Patent Application No. 60/039,919, filed Mar. 7, 1997, now abandoned. Each of these applications is hereby incorporated by reference.

BACKGROUND OF THE INVENTION

During placental development the establishment of fetal-maternal interactions is critical for a successful human pregnancy (1). Abnormalities of placenta formation due to shallow trophoblast invasion have been linked to preeclampsia and fetal growth restriction (2). In contrast, uncontrolled trophoblast invasion and abnormal trophoblast growth are associated with hydatiform mole and choriocarcinoma. In the course of placenta formation, chorionic villous cytotrophoblasts undergo two morphologically distinct pathways of differentiation. The vast majority of cytotrophoblasts in both floating and anchoring villi fuse to form the syncytiotrophoblast layer, which permits gas and nutrient exchange for the developing embryo. A small percentage of cytotrophoblasts in anchoring villi break through the syncytium, at selected sites, and generate columns of non-polarized cells which migrate into the endometrium. These extravillous trophoblasts (EVT) invade deeply into the uterus reaching the first third of the myometrium at which point they invade the spiral arteries, replacing their endothelium and vascular wall. Invasion peaks at 12 weeks of gestation and rapidly declines thereafter, indicating that, unlike tumour invasion, it is spatially and temporally regulated (3). Trophoblast invasion in the decidua is accompanied by a complex modulation of the synthesis and degradation of extracellular matrix (ECM) proteins and in the expression of adhesion molecules (4-6). Along the invasive pathway, ECM proteins undergo changes in their spatial distribution with loss of laminin and appearance of fibronectin (3,4). EVT loose the expression of E-cadherins, responsible for cell-cell adhesion between polarized stem cytotrophoblasts, down-regulate α₆β₄ integrin, a laminin receptor, and acquire α₅β₁ integrin, a fibronectin receptor (7). Once the EVT invade the endometrium they express the α₁β₁ integrin, a collagen/laminin receptor. Thus, specific changes in ECM proteins and their receptors are associated with the acquisition of an invasive phenotype by the extravillous trophoblasts (4).

Preeclampsia occurs in 5-10% of pregnancies and is the leading cause of death and illness in women during pregnancy. Preeclampsia is also associated with considerable fetal/neonatal complications because of adverse intrauterine conditions and preterm delivery. There is currently no effective pharmacologic treatment for preeclampsia and the only remedy is to remove the placenta (and hence deliver the fetus preterm). Current protocols, including bedrest and antihypertensive drugs, seek to stabilize maternal/fetal condition until delivery is necessitated. It is estimated that around 200,000 children are born preterm in North America due to preeclampsia. Many of these babies will require costly intensive care at birth and if they survive may face a lifetime of chronic illness (e.g. lung disease) or disability (e.g. cerebral palsy, mental handicaps, blindness). These conditions represent a significant impact on subsequent requirements for community health care resources. Therefore, reducing the incidence of preeclampsia and preterm birth would have a tremendous positive impact on health care delivery.

SUMMARY OF THE INVENTION

The invention relates to methods and compositions for diagnosing and treating conditions requiring regulation of trophoblast invasion.

The present inventors have studied the mechanisms that regulate trophoblast invasion. The inventors have found that antisense disruption of the expression of the TGFβ receptor, endoglin, triggers invasion of cytotrophoblast from first trimester villous explants in vitro indicating that the TGFβ receptor system, and in particular endoglin, plays a critical role in regulating this process. Significantly, the present inventors defined components that endogenously regulate trophoblast invasion. TGF-β₃ was found to be a major regulator of trophoblast invasion in vitro. In particular, the presence of TGF-β₃ and its receptors at 5-8 weeks at a time when there is no spontaneous trophoblast invasion and the absence of these molecules at 12-13 weeks when spontaneous invasion occurs, establishes a major role for TGF-β₃ as an endogenous inhibitor of trophoblast invasion. Down-regulation of TGF-β₃ (but not β₁ or β₂) expression using antisense oligonucleotides, stimulated extravillous trophoblast cell (EVT) outgrowth/migration and fibronectin production in 5-8 villous explants indicating that TGF-β₃ acts to suppress in vivo trophoblast invasion. The effects of antisense treatment to TGF-β₃ are specific as they are prevented by addition of exogenous TGF-β₃ but not TGF-β₁ or TGF-β₂. The stimulatory effects of TGF-β₃ are lost after 9 weeks of gestation which is compatible with TGF-β₃ being produced by the villi during a specific window of gestation within the first trimester (5-8 weeks) and that inhibition of its synthesis stimulates trophoblast differentiation. Addition of exogenous TGF-β₃ to the villous explants inhibits fibronectin synthesis.

The clinical importance of TGF-β₃ in regulating trophoblast invasion has been highlighted by the finding that TGF-β₃ is highly expressed in trophoblast tissue of preeclamptic patients when compared to that in age-matched control placenta while there was no change in the expression of either the β₁ or β₂ isoform. Fibronectin and α₅ integrin expression were also greater in preeclamptic placenta, indicating that in preeclampsia, where there is shallow trophoblast invasion, trophoblast cells are arrested as an α₅ integrin phenotype producing TGF-β₃. These data are supported by the finding that villous explants from a control (non-preeclamptic placenta, 32 weeks of gestation) spontaneously formed columns of trophoblasts that invaded the surrounding Matrigel, while explants from a preeclamptic placenta did not

In contrast to TGF-β₃, activin, a TGF-β receptor, has been found to trigger trophoblast invasion. Follistatin an activin binding protein inhibited the stimulatory effect of activin, and antibodies and antisense to endoglin.

Oxygen tension was also found to play a role in regulating trophoblast invasion. The expression of the hypoxia inducible factor, HIF-1α, parallels that of TGF-β₃ in first trimester trophoblast (i.e. peaks at 6-8 weeks but decreases after 9-10 weeks when oxygen tension increases). Expression of HIF-1α was dramatically increased in placentas of preeclamptic patients when compared to age-matched control tissue. Induction of HIF-1α by low PO₂ (around 6-8 weeks) up regulates TGF-β₃ transcription and blocks trophoblast invasion. A failure of the system to down-regulate at 9-11 weeks (either due to a block in response to normoxia or the absence of an increase in oxygen tension) leads to shallow invasion and predisposes to preeclampsia.

In addition to endoglin, the present inventors have found that TGF-β₃ signals through a receptor complex which includes RI (ALK1), RII and endoglin. While TGF-β RI (ALK-5) and TGF-β R-II are expressed throughout the villi and decidua at 9-10 weeks gestation, they were found to be absent from the base of the proximal columns of the anchoring villi at the transition zone between the villous and the invading EVT exactly at the site where endoglin is up-regulated. This dramatic change in TGF-β receptor expression indicates that EVT within the columns in situ are not subject to the inhibitory actions of TGFβ, but via R-I and R-II they come under the control of this ligand upon entering the decidua. In addition, antisense induced disruption of RI (ALK-1) and RII expression stimulated trophoblast outgrowth/migration and fibronectin synthesis. In contrast, antisense to RI (ALK-5) inhibited fibronectin synthesis.

Broadly stated the present invention relates to a method for detecting, preventing, and/or treating a condition requiring regulation of trophoblast invasion by modulating (a) TGF-β₃ (b) receptors of cytokines of the TGFβ family, (c) HIF-1α, and/or (d) O₂ tension. In accordance with one aspect of the invention a method is provided for diagnosing in a subject a condition requiring regulation of trophoblast invasion comprising detecting TGF-β₃, receptors of cytokines of the TGFβ family, or HIF-1α, in a sample from the subject. In an embodiment of the diagnostic method of the invention, a method is provided for diagnosing increased risk of preeclampsia in a subject comprising detecting TGF-β₃ or its receptors, or HIF-1α in a sample from the subject.

The invention also broadly contemplates a method for regulating trophoblast invasion comprising inhibiting or stimulating TGF-β₃, receptors of cytokines of the TGFβ family, HIF-1α, or O₂ tension. In an embodiment of the invention, a method is provided for increasing trophoblast invasion in a subject comprising administering to the subject an effective amount of an inhibitor of (a) TGF-β₃, (b) receptors of cytokines of the TGFβ family, and/or (c) HIF-1α. In a preferred embodiment of the invention a method is provided for treating a woman suffering from, or who may be susceptible to preeclampsia comprising administering therapeutically effective dosages of an inhibitor of (a) TGF-β₃, (b) receptors of cytokines of the TGFβ family, and/or (c) HIF-1α. A therapeutically effective dosage is an amount of an inhibitor of (a), (b) and/or (c) effective to down regulate or inhibit TGF-β₃ in the woman.

In another embodiment of the invention, a method is providing for reducing trophoblast invasion in a subject comprising administering an effective amount of (a) TGF-β₃; (b) receptors of cytokines of the TGFβ family; (c) HIF-1α; and/or (d) a stimulator of (a), (b) or (c). In a preferred embodiment, a method is provided for monitoring or treating choriocarcinoma or hydatiform mole in a subject comprising administering therapeutically effective dosages of (a) TGF-β₃; (b) receptors of cytokines of the TGFβ family; (c) HIF-1α; and/or (d) a stimulator of (a), (b) or (c). An amount is administered which is effective to up regulate or stimulate TGF-β₃ in the subject.

The invention also relates to a composition adapted for regulating trophoblast invasion comprising a substance which inhibits or stimulates TGF-β₃, receptors of cytokines of the TGFβ family, and/or HIF-1α, or regulates O₂ tension, in an amount effective to inhibit or stimulate trophoblast invasion, and an appropriate carrier, diluent, or excipient. In an embodiment of the invention, a composition is provided for treating a woman suffering from, or who may be susceptible to preeclampsia, comprising a therapeutically effective amount of an inhibitor of (a) TGF-β₃, (b) receptors of cytokines of the TGFβ family, and/or (c) HIF-1α, and a carrier, diluent, or excipient. In another embodiment of the invention, a composition is provided for monitoring or treating choriocarcinoma or hydatiform mole in a subject comprising a therapeutically effective amount of (a) TGF-β₃; (b) receptors of cytokines of the TGFβ family; (c) HIF-1α; and/or (d) a stimulator of (a), (b) or (c), and a carrier, diluent, or excipient.

The invention further relates to a method of selecting a substance that regulates trophoblast invasion comprising assaying for a substance that inhibits or stimulates TGF-β₃, receptors of a cytokine of the TGFβ family, or HIF-1α. The substances may be used in the methods of the invention to regulate trophoblast invasion.

The invention also relates to kits for carrying out the methods of the invention.

Other objects, features and advantages of the present invention will become apparent from the following detailed description. It should be understood, however, that the detailed description and the specific examples while indicating preferred embodiments of the invention are given by way of illustration only, since various changes and modifications within the spirit and scope of the invention will become apparent to those skilled in the art from this detailed description.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will now be described in relation to the drawings in which:

FIG. 1 shows the amino acid and nucleic acid sequence of TGF-β₃;

FIG. 2 shows the amino acid and nucleic acid sequence of HIF-1α;

FIG. 3A are Southern blots showing expression of TGF-β isoforms in human placenta in the first trimester of gestation;

FIG. 3B are photographs of immunoperoxidase staining of TGF-β₃ performed in placental sections at 5, 8, and 12 weeks of gestation;

FIG. 4A are photographs showing that addition of recombinant TGF-β₃ to antisense TGF-β₃ abolishes the antisense stimulatory effect on trophoblast budding and outgrowth;

FIG. 4B are blots showing the reversal effect on antisense TGF-β₃ stimulatory effect by exogenous TGF-β₃ for fibronectin synthesis;

FIG. 4C is a graph showing the changes in fibronectin estimated after normalization to control cultures;

FIG. 4D are blots showing the effects on gelatinase activity in conditioned media of explants treated with sense or antisense oligonucleotides to TGF-β₃;

FIG. 4E are blots showing that the antisense TGF-β₃ stimulatory effect on fibronectin production is lost after 9 weeks of gestation;

FIG. 5A are blots showing message expression of TGFβ isoforms, α₅ integrin receptor, and fibronectin in preeclamptic and age-matched control placentae;

FIG. 5B are photographs of immunoperoxidase staining of TGF-β₃ performed in placental sections from normal pregnancies and pregnancies complicated by preeclampsia;

FIG. 6A are photographs showing that antisense oligonucleotides to TGF-β₃ induces the formation of trophoblast cells in preeclamptic villous explants;

FIG. 6B shows the results of gelatin Zymography of explants of 32 weeks gestation from preeclamptic placentae treated with antisense or control sense oligonucleotides to TGF-β₃ for 5 days;

FIG. 6C are Western blots with MMP9 antisera of explants of 32 weeks gestation from preeclamptic placentae treated with antisense or control sense oligonucleotides to TGF-β₃ for 5 days;

FIG. 7A is a blot showing expression of HIF-1α placenta in the first trimester of gestation;

FIG. 7B is a blot showing expression of HIF-1α in preeclamptic (PE) and age-matched control placenta (C);

FIG. 8 is a blot showing the effect of low oxygen tension on TGF-β₃ and HIF-1α expression in villous explants;

FIG. 9 are photographs at 20% O₂ and 3% O₂ (25× and 50×) showing the effect of low oxygen tension on villous explant morphology; and

FIG. 10 are photographs showing the effect of antisense to HIF-1α on villous explant morphology.

DETAILED DESCRIPTION OF THE INVENTION

1. Diagnostic Methods

As hereinbefore mentioned, the present invention provides a method for diagnosing in a subject a condition requiring regulation of trophoblast invasion comprising detecting TGF-β₃, receptors of cytokines of the TGFβ family, or HIF-1α in a sample from the subject. In an embodiment of the diagnostic method of the invention, a method is provided for diagnosing increased risk of preeclampsia in a subject comprising detecting TGF-β₃, its receptors, or HIF-1α in a sample from the subject.

TGF-β₃ is a cytokine of the TGFβ family and it has the structural characteristics of the members of the TGFβ family. TGFβ is produced as a precursor characterised by having an N-terminal hydrophobic signal sequence for translocation across the endoplasmic reticulum, a pro-region, and a C-terminal bioactive domain. Prior to release from the cell, the pro-region is cleaved at a site containing four basic amino acids immediately preceding the bioactive domain (Massague, 1990, Annu. Review. Cell Biol. 6:597).

The precursor structure of TGFβ is shared by members of the TGFβ family, with the exception of the TGFβ4 precursor which lacks a distinguishable signal sequence. The degree of identity between family members in the C-terminal bioactive domain is from 25 to 90% (See Basler et al. Cell, 73:687, 1993, FIG. 2). All nine cysteines are conserved in the bioactive domain in the TGFβ family. The bioactive domain is cleaved to generate a mature monomer.

The TGFβ family includes five members, termed TGFβ1 through TGFβ5, all of which form homodimers of about 25 kd (reviewed in Massague, 1990). The family also includes TGFβ1.2 which is a heterodimer containing a β31 and a β2 subunit linked by disulfide bonds. The five TGFβ genes are highly conserved. The mature TGFβ processed cytokines produced from the members of the gene family show almost 100% amino acid identity between species and the five peptides as a group show about 60-80% identity. The amino acid sequence and nucleic acid sequence of TGF-β₃ are shown in FIG. 1 (See also sequences for GenBank Accession Nos. HSTGF31-HSTGF37 and HSTGFβ3M).

“Receptors of cytokines of the TGFβ family” or “TGFβ receptors” refers to the specific cell surface receptors which bind to cytokines of the TGFβ family, in particular TGF-β₃, including the TGF-β type I receptor (ALK-1 or ALK-5)) (R-I), TGF-β type II receptor (R-II), betaglycan, endoglin and activin, and complexes of the receptors, in particular a RI-RII-endoglin complex. Endoglin binds TGFβ₁ and β₃ with high affinity (K_(D)=50 pM). Betaglycan has considerable sequence homology to endoglin (Chiefetz, S., et al J. Biol. Chem. 267: 19027, 1992; Lopez-Casillas, F., et al, Cell 67:785, 1991; Wang, X. F., et al, Cell 67:797, 1991), it can bind all three forms of TGF-β₃, and it regulates access of the ligands to R-I and R-II which are serine/threonine kinases and unlike betaglycan, are necessary for signal transduction (Wrana, J. L. et al, Cell 71:1003, 1992, Lopez-Casillas et al, Cell 73:1435, 1993; Franzen, P., et al Cell 75:681, 1993; Laiho, M. et al, J. Biol. Chem. 266:9108; Massague, J. et al, Trends Cell Biol. 4:172, 1994). TGFβ R-II is an integral membrane protein which contains a short extracellular domain, a single transmembrane domain, and an intracellular serine/threonine kinase domain (Lin H. Y. et al., Cell 68:775, 1992). Serine/threonine kinases encoding type II receptors have been cloned which are structurally related to the type II receptors (Wrana, J. L. et al, Cell 71:1003, 1992, ten Dikje, P., et al, Oncogene 8:2879, 1993; Ebner, R., et al Science 260:1344, 1993; Ebner, R., et al Science 262:900, 1993). TGFβ R-I (human ALK-5), binds TGFβ₁ and β₃ only in the presence of TGFβ R-II (Wrana, J. L. et al, Cell 71:1003, 1992). The human ALK-1 (TGFβ R-I) binds TGFβ when forming a heterodimeric complex with TGFβ R-II (Franzen, P., et al Cell 75:681, 1993). TGFβ R-II kinase, which is endogenously phosphorylated, phosphorylates and activates R-I which then initiates further downstream signals (Wrana, J. L. et al, Nature 370:341, 1994).

Hypoxia-inducible factor-I (HIF-1) is present in nuclear extracts of many mammalian cells cultivated in a low oxygen atmosphere (Semenza, G. L. et al Mol. Cell. Biol. 12:5447, 1992; Wang, G. L. et al J. Biol. Chem. 268:21513, 1993). HIF-I binds as a phosphoprotein to a short DNA motif (BACGTSSK) identified in the 3′-flanking regions of many hypoxia-induced genes (Semenza, G. L. et al. J. Biol Chem 269:23757, 1994; Liu, Y., et al Circulation Res. 77:638, 1995; Firth, J. D. et al Proc. Natl. Acad, Sci. U.S.A. 91:6496, 1994; Abe, M., et al, Anal. Biochem. 216:276, 1994). HIF-I binds DNA as a heterodimeric complex composed of two subunits of the inducible HIF-1α and the constitutively expressed HIF-Iβ.

TGF-β₃, receptors of cytokines of the TGFβ family (e.g., TGFβ RI (ALK-1), TGFβ RII, or a complex of RI-RII-endoglin), or HIF-1α may be detected in a variety of samples from a patient. Examples of suitable samples include cells (e.g. fetal or maternal); and, fluids (fetal or maternal), including for example, serum, plasma, amniotic fluid, saliva, and conditioned medium from fetal or maternal cells.

TGF-β₃, receptors of cytokines of the TGFβ family, or HIF-1α may be detected using a substance which directly or indirectly interacts with the cytokine, TGFβ receptors, or HIF-1α. For example, antibodies specific for TGF-β₃, the TGFβ receptors, or HIF-1α may be used to diagnose and monitor a condition requiring regulation of trophoblast invasion. A method of the invention using antibodies may utilize Countercurrent Immuno-Electrophoresis (CIEP), Radioimmunoassays, Radioimmunoprecipitations, and Enzyme-Linked Immuno-Sorbent Assays (ELISA), Dot Blot assays, Inhibition or Competition assays and sandwich assays (see U.S. Pat. Nos. 4,376,110 and 4,486,530; see also Antibodies: A Laboratory Manual, supra).

Antibodies used in the methods of the invention include monoclonal antibodies, polyclonal antibodies, antibody fragments (e.g., Fab, and F(ab′)₂ and recombinantly produced binding partners. Polyclonal antibodies may be readily generated by one of ordinary skill in the art from a variety of warm-blooded animals such as horses, cows, various fowl, rabbits, mice, or rats. Monoclonal antibodies may also be readily generated using conventional techniques (see U.S. Pat. Nos. RE 32,011, 4,902,614, 4,543,439, and 4,411,993 which are incorporated herein by reference; see also Monoclonal Antibodies, Hybridomas: A New Dimension in Biological Analyses, Plenum Press, Kennett, McKearn, and Bechtol (eds.), 1980, and Antibodies: A Laboratory Manual, Harlow and Lane (eds.), Cold Spring Harbor Laboratory Press, 1988, which are also incorporated herein by reference). Binding partners may be constructed utilizing recombinant DNA techniques to incorporate the variable regions of a gene which encodes a specifically binding antibody (See Bird et al., Science 242:423-426, 1988).

Antibodies may also be obtained from commercial sources. For example, antibodies to TGF-β₃ may be obtained from American Diagnostics Inc., CT. U.S.A., Oncogene Science, NY, U.S.A., and Dimension Laboratories, Mississauga, Canada.

The presence of TGF-β₃ in a sample may also be determined by measuring the binding of the cytokine to compounds which are known to interact with TGF-β₃ such as its receptors, or decorin, thrombospondin, the serum glycoprotein α2-macroglobulin, fetuin, or thyroglobulin (Y. Yamaguchi, D. M. Mann, E. Ruoslahti, Nature 346, 281 (1990); S. Scholtz-Chemy J. E. Murphy-Ullrich, J. Cell Biol. 122, 923 (1993); O'Conner-McCourt, L, M. Wakefield J. Biol. Chem. 262, 14090 (1987); and J. Massague Curr. Biol. 1, 117 (1991)). These compounds are referred to herein as “TGFβ Binding Compounds”.

The presence of receptors of cytokines of the TGFβ family may be determined by measuring the binding of the receptors to molecules (or parts thereof) which are known to interact with the receptors such as their ligands. In particular, peptides derived from sites on ligands which bind to the receptors may be used. A peptide derived from a specific site on a ligand may encompass the amino acid sequence of a naturally occurring binding site, any portion of that binding site, or other molecular entity that functions to bind an associated molecule. A peptide derived from such a site will interact directly or indirectly with an associated receptor molecule in such a way as to mimic the native binding site. Such peptides may include competitive inhibitors, enhancers, peptide mimetics, and the like as discussed below.

The presence of HIF-1α may be determined by measuring the binding of HIF-α1 to DNA molecules which are known to interact with HIF-α1 such as hypoxia inducing genes. The TGFβ binding compounds and molecules that interact with the receptors and HIF-1α are referred to herein as “Binding Compounds”.

The antibodies specific for the TGF-β₃, TGFβ receptors, or HIF-1α, or the Binding Compounds may be labelled using conventional methods with various enzymes, fluorescent materials, luminescent materials and radioactive materials. Examples of suitable enzymes include horseradish peroxidase, alkaline phosphatase, β-galactosidase, or acetylcholinesterase; examples of suitable fluorescent materials include umbelliferone, fluorescein, fluorescein isothiocyanate, rhodamine, dichlorotriazinylamine fluorescein, dansyl chloride or phycoerythrin; an example of a luminescent material includes luminol; and examples of suitable radioactive materials include radioactive phosphorous ³²P, iodine I¹²⁵, I¹³¹ or tritium.

An antibody to TGF-β₃, a TGFβ family receptor, or HIF-1α, or a Binding Compound may also be indirectly labelled with a ligand binding partner. For example, the antibodies, or a TGF-β₃ Binding Compound may be conjugated to one partner of a ligand binding pair, and the TGF-β₃ may be coupled to the other partner of the ligand binding pair. Representative examples include avidin-biotin, and riboflavin-riboflavin binding protein. Preferably the antibodies are biotinylated. Methods for conjugating the antibodies discussed above with the ligand binding partner may be readily accomplished by one of ordinary skill in the art (see Wilchek and Bayer, “The Avidin-Biotin Complex in Bioanalytical Applications,” Anal Biochem. 171:1-32, 1988).

The antibodies or Binding Compounds used in the method of the invention may be insolubilized. For example, the antibodies or Binding Compounds may be bound to a suitable carrier. Examples of suitable carriers are agarose, cellulose, dextran, Sephadex, Sepharose, carboxymethyl cellulose polystyrene, filter paper, ion-exchange resin, plastic film, plastic tube, glass beads, polyamine-methyl vinyl-ether-maleic acid copolymer, amino acid copolymer, ethylene-maleic acid copolymer, nylon, silk, etc. The carrier may be in the shape of, for example, a tube, test plate, beads, disc, sphere etc. The insolubilized compound or antibodies may be prepared by reacting the material with a suitable insoluble carrier using known chemical or physical methods, for example, cyanogen bromide coupling.

Indirect methods may also be employed in which a primary antigen-antibody reaction is amplified by the introduction of a second antibody, having specificity for the antibody reactive against the cytokine. By way of example, if the antibody having specificity against TGF-β₃ is a rabbit IgG antibody, the second antibody may be goat anti-rabbit gamma-globulin labelled with a detectable substance as described herein.

TGF-β₃, TGFβ receptors, or HIF-1α can also be assayed in a sample using nucleotide probes to detect nucleic acid molecules encoding a TGF-β₃, the TGFβ receptors, or HIF-1α. Suitable probes include nucleic acid molecules based on nucleic acid sequences encoding TGF-β₃, the TGFβ receptors, or HIF-1α. A nucleotide probe may be labelled with a detectable substance such as a radioactive label which provides for an adequate signal and has sufficient half-life such as ³²P, ³H, ¹⁴C or the like. Other detectable substances which may be used include antigens that are recognized by a specific labelled antibody, fluorescent compounds, enzymes, antibodies specific for a labelled antigen, and luminescent compounds. An appropriate label may be selected having regard to the rate of hybridization and binding of the probe to the nucleotide to be detected and the amount of nucleotide available for hybridization Labelled probes may be hybridized to nucleic acids on solid supports such as nitrocellulose filters or nylon membranes as generally described in Sambrook et al, 1989, Molecular Cloning, A Laboratory Manual (2nd ed.).

A nucleic acid molecule encoding TGF-β₃, TGFβ receptors, or HIF1α can also be detected by selective amplification of the nucleic acid molecules using polymerase chain reaction (PCR) methods. Synthetic oligonucleotide primers can be constructed from the sequences of the TGF-β₃, TGFβ receptors, or HIF1α using conventional methods. A nucleic acid can be amplified in a sample using these oligonucleotide primers and standard PCR amplification techniques.

In a preferred embodiment of the invention, a method is provided for diagnosing increased risk of preeclampsia in a subject comprising detecting TGF-β₃, TGFβ R-I (ALK-1), TGFβ R-II, endoglin, HIF-1α, or a complex of R-I (ALK-1)-R-II-endoglin in a sample, and in particular using antibodies specific for TGF-β₃. Levels of TGF-β₃, TGFβ receptors or complexes thereof, or HIF-1α may be measured during the first trimester of pregnancy (approximately 1 to 14 weeks). It is preferred that at least two measurements be taken during this period, preferably including a measurement at about 14 to 16 weeks. If the levels are significantly increased as compared to levels typical for women who do not suffer from preeclampsia, the patient is diagnosed as having an increased risk of suffering preeclampsia. Levels above those typical for women who do not suffer from preeclampsia may be suspect and further monitoring and measurement of TGF-β₃, TGFβ receptors, or HIF-1α may be appropriate. The information from the diagnostic method may be used to identify subjects who may benefit from a course of treatment, such as treatment via administration of inhibitors of TGF-β₃ as discussed herein.

It will also be appreciated that the above methods may also be useful in the diagnosis or monitoring of choriocarcinoma or hydatiform mole which involves uncontrolled trophoblast invasion (i.e. may be associated with abnormally low levels of TGF-β₃, TGFβ family receptors, or HIF1α). Further the above methods may be used to diagnose or monitor other pregnancy complications including intrauterine growth restriction, molar pregnancy, preterm labour, preterm birth, fetal anomalies, and placental abruption. The diagnostic and monitoring methods of the invention may also involve determining responsiveness of cells to oxygen.

The invention also relates to kits for carrying out the methods of the invention. The kits comprise instructions, negative and positive controls, and means for direct or indirect measurement of TGF-β₃, TGFβ receptors, or HIF1α.

2. Regulation of Trophoblast Invasion in a Subject

The invention also provides a method of regulating trophoblast invasion comprising directly or indirectly inhibiting or stimulating (a) TGF-β₃ (b) receptors of cytokines of the TGFβ family, (c) HIF1α; and/or (d) O₂ tension, preferably inhibiting or stimulating TGF-β₃. Trophoblast invasion may also be regulated by optimizing oxygenation of tissues.

In an embodiment of the invention, a method is provided for increasing trophoblast invasion in a subject comprising administering an effective amount of a substance which is an inhibitor of (a) TGF-β₃, (b) receptors of cytokines of the TGFβ family, and/or (c) HIF-1α. In particular, methods are provided for treating a women suffering from or who may be susceptible to preeclampsia.

In another embodiment of the invention, a method is providing for reducing trophoblast invasion in a subject comprising administering an effective amount of (a) TGF-β₃; (b) receptors of cytokines of the TGFβ family; (c) HIF-α1; and/or (d) a stimulator of (a), (b) or (c). The method may be used to monitor or treat choriocarcinoma or hydatiform mole.

The methods of the invention may also be used to monitor or treat other complications of pregnancy such as intrauterine growth restriction, molar pregnancy, preterm labour, preterm birth, fetal anomalies, or placental abruption.

Substances that regulate trophoblast invasion can be selected by assaying for a substance that inhibits or stimulates the activity of TGF-β₃, TGFβ receptors, or HIF-1α. A substance that regulates trophoblast invasion can also be identified based on its ability to specifically interfere or stimulate the interaction of (a) TGF-β₃ and a receptor for the cytokine (e.g. the interaction of TGF-β₃ and endoglin, or TGF-β₃ and R-I, R-II, or a complex of R-I-R-II endoglin, or (b) TGF-β₃ and HIF1α.

Therefore, a method is provided for evaluating a compound for its ability to regulate trophoblast invasion comprising the steps of:

(a) reacting TGF-β₃ or a part thereof that binds to a receptor of a cytokine of the TGFβ family, with a receptor of a cytokine of the TGFβ family or a part thereof that binds to TGF-β₃, and a test substance, wherein the TGF-β₃ and receptor of a cytokine of the TGFβ family or parts thereof, are selected so that they bind to form a ligand-receptor complex; and

(b) comparing to a control in the absence of the substance to determine the effect of the substance.

In particular, a method is provided for identifying a substance which regulates trophoblast invasion comprising the steps of:

(a) reacting TGF-β₃ or a part thereof that binds to a receptor of a cytokine of the TGFβ family, and a receptor of a cytokine of the TGFβ family or a part thereof that binds to TGF-β₃, and a test substance, wherein the TGF-β₃ and receptor of a cytokine of the TGFβ family or parts thereof, are selected so that they bind to form a ligand-receptor complex, under conditions which permit the formation of ligand-receptor complexes, and

(b) assaying for complexes, for free substance, for non-complexed TGF-β₃ or receptor, or for activation of the receptor.

The substance may stimulate or inhibit the interaction of TGFβ or a part thereof that binds the TGFβ receptor, and the TGFβ receptor.

In an embodiment of the invention a receptor complex is employed comprising TGFβ R-I (ALK-1)-TGFβ RII-endoglin.

Activation of the receptor may be assayed by measuring phosphorylation of the receptor, or by assaying for a biological affect on a cell, such measuring biochemical markers of trophoblast invasion such as cell proliferation, FN synthesis, integrin expression, up regulation of gelatinase and type IV collagenase expression and activity.

The invention also provides a method for evaluating a substance for its ability to regulate trophoblast invasion comprising the steps of:

(a) reacting TGF-β₃ or a part of TGF-β₃ that binds to HIF-1α, HIF-1α or a part of the protein that binds to TGF-β₃, and a test substance, wherein the TGF-β₃ or part thereof, and HIF-1α or part thereof bind to form a TGF-β3-HIF-1α complex; and

(b) comparing to a control in the absence of the substance to determine the effect of the substance.

The substance may stimulate or inhibit the interaction of TGF-β₃ and HIF-1α, or the activation of TGFβ by HIF-1α and thereby regulate trophoblast invasion.

The substances identified using the methods of the invention include but are not limited to peptides such as soluble peptides including Ig-tailed fusion peptides, members of random peptide libraries and combinatorial chemistry-derived molecular libraries made of D- and/or L-configuration amino acids, phosphopeptides (including members of random or partially degenerate, directed phosphopeptide libraries), antibodies [e.g. polyclonal, monoclonal, humanized, anti-idiotypic, chimeric, single chain antibodies, fragments, (e.g. Fab, F(ab)₂, and Fab expression library fragments, and epitope-binding fragments thereof)], and small organic or inorganic molecules. The substance may be an endogenous physiological compound or it may be a natural or synthetic compound. The substance may be a TGFβ R-I-TGFβ R-II-endoglin complex, which competitively inhibits the binding of TGF-β₃ to its natural receptors. The invention contemplates isolated TGFβ R-I-TGFβ R-II-endoglin complexes and their use in regulating trophoblast invasion.

The substances may be peptides derived from the binding sites of TGF-β₃ and a receptor for the cytokine such as endoglin, R-I or R-II, or a complex of R-I-R-II-endoglin; or the binding sites of TGF-β₃ and HIF1α. A peptide derived from a specific binding site may encompass the amino acid sequence of a naturally occurring binding site, any portion of that binding site, or other molecular entity that functions to bind an associated molecule. A peptide derived from such a binding site will interact directly or indirectly with an associated molecule in such a way as to mimic the native binding domain. Such peptides may include competitive inhibitors, enhancers, peptide mimetics, and the like. All of these peptides as well as molecules substantially homologous, complementary or otherwise functionally or structurally equivalent to these peptides may be used for purposes of the present invention.

“Peptide mimetics” are structures which serve as substitutes for peptides in interactions between molecules (See Morgan et al (1989), Ann. Reports Med. Chem. 24:243-252 for a review). Peptide mimetics include synthetic structures which may or may not contain amino acids and/or peptide bonds but retain the structural and functional features of a peptide, or enhancer or inhibitor of the invention. Peptide mimetics also include peptoids, oligopeptoids (Simon et al (1972) Proc. Natl. Acad, Sci U.S.A. 89:9367); and peptide libraries containing peptides of a designed length representing all possible sequences of amino acids corresponding to a peptide of the invention.

Peptides may be synthesized by conventional techniques. For example, the peptides may be synthesized by chemical synthesis using solid phase peptide synthesis. These methods employ either solid or solution phase synthesis methods (see for example, J. M. Stewart, and J. D. Young, Solid Phase Peptide Synthesis, 2^(nd) Ed., Pierce Chemical Co., Rockford Ill. (1984) and G. Barany and R. B. Merrifield, The Peptides: Analysis Synthesis, Biology editors E. Gross and J. Meienhofer Vol. 2 Academic Press, New York, 1980, pp. 3-254 for solid phase synthesis techniques; and M Bodansky, Principles of Peptide Synthesis, Springer-Verlag, Berlin 1984, and E. Gross and J. Meienhofer, Eds., The Peptides: Analysis, Synthesis, Biology, supra, Vol 1, for classical solution synthesis.)

Peptide mimetics may be designed based on information obtained by systematic replacement of L-amino acids by D-amino acids, replacement of side chains with groups having different electronic properties, and by systematic replacement of peptide bonds with amide bond replacements. Local conformational constraints can also be introduced to determine conformational requirements for activity of a candidate peptide mimetic. The mimetics may include isosteric amide bonds, or D-amino acids to stabilize or promote reverse turn conformations and to help stabilize the molecule. Cyclic amino acid analogues may be used to constrain amino acid residues to particular conformational states. The mimetics can also include mimics of inhibitor peptide secondary structures. These structures can model the 3-dimensional orientation of amino acid residues into the known secondary conformations of proteins. Peptoids may also be used which are oligomers of N-substituted amino acids and can be used as motifs for the generation of chemically diverse libraries of novel molecules.

A substance that regulates trophoblast invasion may be a molecule which interferes with the transcription and/or translation of TGF-β₃, TGFβ receptors, or HIF-1α. For example, the sequence of a nucleic acid molecule encoding TGF-β₃, TGFβ receptors (e.g. endoglin, R-I (ALK-1), R-II, or RI-RIII-endoglin complex), or fragments thereof, may be inverted relative to its normal presentation for transcription to produce an antisense nucleic acid molecule. An antisense nucleic acid molecule may be constructed using chemical synthesis and enzymatic ligation reactions using procedures known in the art. Examples of antisense molecules for TGF-β₃ are 5′-CCTTTGCAAGTGCATC-3′ (SEQ ID NO: 1) and 5′-GATGCACTTGCAAAGG-3′ (SEQ ID NO: 2).

The treatment methods and compositions described herein may use substances that are known inhibitors of TGF-β₃. For example, antibodies to TGF-β₃, the TGFβ Binding Compounds including decorin, α2-macroglobulin, fetuin, and thyroglobulin, or peptides derived from the sites on these compounds that bind to TGF-β₃, or chimeras of these molecules may be employed.

Activin, another member of the TGFβ receptor family, triggers trophoblast invasion and therefore it may be used to enhance trophoblast invasion in a subject.

The utility of a selected inhibitor or stimulator may be confirmed in experimental model systems. For example, the human villous explant culture system described by Genbacev et al. (21) can be used to confirm the utility of an inhibitor for treatment of preeclampsia.

In a preferred embodiment of the invention a method is provided for treating a woman suffering from, or who may be susceptible to preeclampsia comprising administering therapeutically effective dosages of an inhibitor of TGF-β₃ or TGFβ receptors, an inhibitor of HIF-1α, or a substance identified in accordance with the methods of the invention. Preferably treatment with the inhibitor begins early in the first trimester, at about 10 to about 16 weeks, and may continue until measured TGF-β₃ levels, TGF-β receptor levels, or HIF-1α levels are within the normal range. Preferably, treatment with the inhibitor or substance is not continued beyond about 30 weeks of gestation. For the purposes of the present invention normal TGF-β₃ levels, TGFβ receptor levels, or HIF-1α levels are defined as those levels typical for pregnant women who do not suffer from preeclampsia. Treatment with the inhibitor is discontinued after TGF-β₃ levels, TGF-β receptor levels, and/or HIF-1α levels are within normal range, and before any adverse effects of administration of the inhibitor are observed.

One or more inhibitors or one or more stimulators of TGF-β₃, TGFβ receptors, or HIF-1α, or substances selected in accordance with the methods of the invention including Binding Compounds, may be incorporated into a composition adapted for regulating trophoblast invasion. In an embodiment of the invention, a composition is provided for treating a woman suffering from, or who may be susceptible to preeclampsia, comprising a therapeutically effective amount of an inhibitor of TGF-β₃, TGFβ receptors, or HIF-1α, or substance selected in accordance with the methods of the invention including TGFβ Binding Compounds, and a carrier, diluent, or excipient.

The compositions of the invention contain at least one inhibitor or stimulator of TGF-β₃, TGFβ receptors, or HIF-1α, or substance identified in accordance with the methods of the invention, alone or together with other active substances. Such compositions can be for oral, parenteral, or local use. They are therefore in solid or semisolid form, for example pills, tablets, and capsules.

The composition of the invention can be intended for administration to subjects such as humans or animals. The pharmaceutical compositions can be prepared by per se known methods for the preparation of pharmaceutically acceptable compositions which can be administered to patients, and such that an effective quantity of the active substance is combined in a mixture with a pharmaceutically acceptable vehicle, carrier or diluent. Suitable vehicles are described, for example, in Remington's Pharmaceutical Sciences (Remington's Pharmaceutical Sciences, Mack Publishing Company, Easton, Pa., U.S.A. 1985).

The compositions of the invention may be administered together with or prior to administration of other biological factors that have been found to affect trophoblast proliferation. Examples of these factors include IL-11 (Ireland et al Blood 84:267a, 1994), G-CSF, GM-CSF and M-CSF (U.S. Pat. No. 5,580,554 to Keith).

The compositions and other biological factors may be administered through any known means. Systemic administration, such as intravenous or subcutaneous administration is preferred. A therapeutically effective amount of an active ingredient e.g. inhibitor is an amount effective to elicit the desired therapeutic response but insufficient to cause a toxic reaction. The dosage for the compositions is determined by the attending physician taking into account factors such as the condition, body weight, diet of the subject, and the time of administration.

For example, a therapeutically effective dose of an inhibitor, e.g. an amount sufficient to lower levels of TGF-β₃ to normal levels, is about 1 to 200 μg/kg/day. The method of the invention may involve a series of administrations of the composition. Such a series may take place over a period of 7 to about 21 days and one or more series may be administered. The composition may be administered initially at the low end of the dosage range and the dose will be increased incrementally over a preselected time course.

An inhibitor or stimulator of TGF-β₃, receptors of cytokines of the TGFβ family, or HIF-1α, or substance identified in accordance with the methods of the invention may be administered by gene therapy techniques using genetically modified trophoblasts or by directly introducing genes encoding the inhibitors or stimulators of TGF-β₃, or receptors of cytokines of the TGFβ family, or substances into trophoblasts in vivo. Trophoblasts may be transformed or transfected with a recombinant vector (e.g. retroviral vectors, adenoviral vectors and DNA virus vectors). Genes encoding inhibitors or stimulators, or substances may be introduced into cells of a subject in vivo using physical techniques such as microinjection and electroporation or chemical methods such as coprecipitation and incorporation of DNA into liposomes. Antisense molecules may also be introduced in vivo using these conventional methods.

The following non-limiting examples are illustrative of the present invention:

EXAMPLE 1

Materials and Methods

Establishment of Human Trophoblast Villous Explant Culture

Villous explant cultures were established from first trimester human placentae by a modification of the method of Genbacev et al. (21). First trimester human placentae (5-8 weeks gestation) were obtained from elective terminations of pregnancies by dilatation and curettage. Placental tissue was placed in ice-cold phosphate buffered saline (PBS) and processed within two hours of collection. The tissue was washed in sterile PBS, and aseptically dissected using a microscope to remove endometrial tissue and fetal membranes. Small fragments of placental villi (15-20 mg wet weight) were teased apart and placed on a transparent Biopore™ membrane of 12-mm diameter Millicell®-CM culture dish inserts with a pore size of 0.4 μm (Millipore Corp, Bedford, Mass.). The inserts were precoated with 0.2 ml of undiluted Matrigel® reagent (Collaborative Research Inc), polymerized at 37° C. for 30 min, and transferred in a 24-well culture dish. Explants were cultured in DMEM/F12 (Gibco, Grand Island, N.Y.) supplemented with 100 μg/ml streptomycin, 100 U/ml penicillin and 0.25 μg/ml ascorbic acid, pH 7.4. Culture media were changed every 48 h and collected for measurement of human chorionic gonadotropin (hCG) and progesterone. Villous explants were kept in culture for up to 6 days. Flattening of the distal end of the villous tips, their adherence to Matrigel® reagent and the appearance of extravillous trophoblast cells (EVT) breaking through from the tips, were used as markers of morphological integrity and trophoblast differentiation as previously described by Genbacev et al. (21). EVT cell outgrowth and migration were consistently monitored and quantitated using the ratio of EVT outgrowths/villous tip, where the nominator, EVT outgrowths, represents the number of extravillous trophoblast columns sprouting from the villous tips plus the number of islands of EVT invading into the Matrigel. The denominator represents the total number of villous tips in a single explant culture. EVT outgrowth from the distal end of the villous tips and their migration into the surrounding matrix were observed for up to 6 days in culture.

Initial experiments, in the presence of 10% (v/v) fetal bovine serum (FBS), demonstrated that DMEM/F12 supported greater EVT sprouting and migration than DMEM. In order to study the effect of various agents on EVT differentiation, a serum-free villous explant culture system was developed. Villous explants of 5-8 weeks gestation were incubated overnight in DMEM/F12 or DMEM/F12+10% (v/v) FBS to promote attachment of the distal villous tips to the Matrigel® reagent. Following this incubation period, explants were washed with fresh medium and cultured in either serum-free DMEM/F12 or DMEM/F12 supplemented with varying concentrations of FBS (0.5% and 10%). In serum-free medium EVT/villous tip was 1.58±0.08 while it was 1.32±0.17 in 0.5% FBS and 1.26±0.02 in 10% FBS (mean±s.e.m. of 3 separate experiments, each carried out in triplicate), suggesting that villous explant cultures were viable for at least 6 days in a serum-free medium. All subsequent experiments were performed with DMEM/F12 in the absence of serum.

The viability of the explant cultures was assessed by measuring hCG and progesterone production rate in the culture media collected at the time of media change every 48 h. Both hCG and progesterone concentrations were measured by radioimmunoassays (Coat-A-Count® HCG IRMA kit and progesterone; DPC, Los Angeles, Calif.). Results are expressed for progesterone as ng/0.1 g wet weight tissue and for hCG as IU/0.1 g wet weight tissue.

Antibodies

Murine monoclonal antibody (MAb) 44G4 specific for human endoglin was produced as previously described (22). IgG purified from ascites was used in all functional assays. Rat MAb 7D3 against cytokeratin was a gift from Drs. S. Fisher and C. Damsky (San Francisco, Calif., U.S.A.). Murine MAb TS2/7 against the α₁ integrin subunit was provided by Dr. M. Hemler (Boston, Mass., U.S.A.). Mouse MAb P1D6 against the α₅ integrin subunit was from Chemicon (Temecula, Calif.); rat MAb GoH3 against the α₆ integrin subunit was purchased from Serotec Canada (Toronto, Ont. Canada) and the neutralizing rabbit polyclonal antibody to TGF-β was from R&D (Minneapolis, Minn.). Purified mouse IgG from Coulter (Hialeah, Fla.) and rat IgG from Sigma (Diagnostic, Toronto, Ont. Canada) were used as negative controls.

Immunohistochemistry

Villous explants kept in culture for 6 days in the presence or absence of antisense oligonucleotides to endoglin were dissected away from the insert membrane with the supporting Matrigel. Explants and placental tissue of 9 weeks gestation were fixed for 1 h at 4° C. in 4% (vol/vol) paraformaldehyde, cryoprotected by incubation in 10% (vol/vol) glycerol for 30 min and 50% (vol/vol) OCT compound (Tissue Tek, Miles, Ind.) for 18 h, embedded in 100% OCT and frozen in liquid nitrogen. Ten micron sections were cut with a cryostat and mounted on poly-L-lysine coated slides. To verify the quality of the tissue and select the most representative sections, every tenth one was stained with haematoxylin and eosin; neighboring sections were selected and stained using the avidin-biotin immunoperoxidase method. Endogenous peroxidase enzyme activity was quenched with 3% (vol/vol) hydrogen peroxide in 0.01 M Tris-HCl, pH 7.4, containing 0.15 M NaCl, or methanol for 10 minutes. Non-specific binding sites were blocked using 5% (vol/vol) normal horse serum (NHS) and 1% (wt/vol) BSA in Tris-buffer for 40 min at 23° C. In the case of murine monoclonal antibodies, a higher background was observed and it was necessary to preincubate the sections with 5% (wt/vol) Texas Red®-conjugated goat anti-mouse IgG antibody for 1 h at 23° C. prior to incubation with primary antibody at 4° C. for 1 h. Optimal antibody concentrations were established in preliminary experiments by titration and were used as follows: 44G4, 5 μg/ml; rabbit anti-TGF-13, 20 μg/ml; P1D6, 20 μg/ml; GoH3, 0.5 μg/ml; TS2/7, 20 μg/m1; 7D3, 10 μg/ml. The slides were washed three times with Tris-buffer, then incubated with a 200-fold dilution of biotinylated goat anti-rabbit IgG or a 300-fold dilution of biotinylated horse anti-mouse or anti-rat IgG, for 1 h at 4° C. After washing three times with Tris-buffer, the slides were incubated with an avidin-biotin complex for 1 h. Slides were washed again in Tris-buffer and developed in 0.075% (wt/vol) 3,3-diaminobenzidine in Tris-buffer, pH 7.6, containing 0.002% (vol/vol) H₂O₂ giving rise to a brown product. After light counterstaining with toluidine blue, slides were dehydrated in an ascending ethanol series, cleared in xylene, and mounted. In control experiments, primary antibodies were replaced with non-immune mouse or rat IgG, or blocking solution [5% (vol/vol) NGS and 1% (wt/vol) BSA].

Effect of Antibody to Endoglin on EVT Formation

Villous explants, prepared from placentae of 5-8 weeks gestation, were incubated for 16 h in DMEM/F12. Explant cultures were then washed with fresh serum-free medium and incubated in serum-free DMEM/F12 medium containing increasing concentrations of MAb 44G4 IgG (0.1 to 10 μg/ml). DMEM/F12 medium±antibody was replaced every 48 h. Antibody addition was thus performed on day 1, 3 and 5 of culture. Morphological integrity of villous explants and their EVT differentiation were monitored daily for up to 6 days.

Antisense Oligonucleotides and their Effects on EVT Formation

Phosphorothioate oligonucleotides (ON) were synthesized on a DNA synthesizer and purified by capillary electrophoresis. Oligonucleotides of 16 base pairs targeted against sequences adjacent to the AUG initiation codon of human endoglin (23) mRNA were synthesized. Previous studies have demonstrated that antisense oligonucleotides, targeted to sequences adjacent to initiation codons, are most efficient in inhibiting translation (24). Furthermore, 16-mer oligonucleotides are short enough to be taken up efficiently and provide sufficient specificity for hybridization to the corresponding target mRNA (24). The sequences of the antisense and sense endoglin oligonucleotides were 5′-GCGTGCCGCGGTCCAT-3′ (SEQ ID NO: 3) and 5′-ATGGACCGCGGCACGC-3′ (SEQ ID NO: 4), respectively. An oligomer with the same composition as the antisense oligonucleotide, but with a scrambled sequence, 5′-GCGGGCCTCGTTCCAG-3′ (SEQ ID NO: 5), was also synthesized and used as a negative control. Oligonucleotides were dissolved in water and their concentration was estimated by optical density at OD₂₆₀. Antisense or sense oligonucleotides (5-10 μM) were added to the villous explants on day 1 and day 3 of culture. EVT sprouting and migration from the distal end of the villous tips were recorded daily for up to 6 days.

Fibronectin Production

Villous explants of 5-8 weeks gestation were incubated overnight in DMEM/F12. Explants were then washed and incubated in DMEM/F12 containing either 10 μg/ml MAb 44G4 or non-immune IgG, 10 μM antisense, scrambled or sense endoglin oligonucleotides. The medium with or without the various agents was changed on day 3 and was replaced on day 5 by methionine-cysteine free low glucose DMEM containing 25 μCi/ml of [³⁵S]methionine/cysteine with or without the same antibodies or oligonucleotides. The cultures were metabolically labelled for 18 h. Conditioned culture media were collected and diluted with an equal amount of 25 mM Tris-HCl buffer, pH 7.4, 0.15 M NaCl and 0.5% (v/v) Triton® X-100 reagent and fibronectin was isolated using gelatin-Sepharose® reagent as previously described (25). Briefly, 50 μl of the gelatin-Sepharose® reagent suspension was added to 500 μl of medium and the samples were incubated overnight at 4° C. The gelatin-Sepharose® beads were centrifuged, washed three times in Tris/Triton® X-100 buffer and fibronectin was eluted by boiling for 5 mM in 1% (v/v) SDS and electrophoresed on a 4-12% (w/v) polyacrylamide gradient gels. Radiolabeled fibronectin was revealed by autoradiography and quantitated using a PhosphoImager™ instrument (410A and Image Quant software, Molecular Dynamics).

[³H]Thymidine Incorporation into DNA

Villous explants of 5-8 weeks gestation, cultured for 48 h with and without antisense ON to endoglin, were incubated in the presence of 1 μCi of [³H]thymidine per milliliter of medium. After 6 h of incubation explants were washed with PBS, fixed in 4% paraformaldehyde for 1 h, embedded in OCT and processed for cryostat sections as previously described. Ten micron sections were mounted on 3-amino-propyl-tryethoxysilane-precoated slides and coated with NBT-2 emulsion (Eastman Kodak, Rochester, N.Y.). Slides were developed after 3 days using Kodak D-19® developer, counterstained with eosin and examined by bright-field microscopy.

Data Analysis

All data are presented as means±s.e.m. of at least three separate experiments carried out in triplicate. Statistical significance was determined by Student's (t)-test for paired groups and by one-way analysis of variance followed by assessment of differences using Student-Newman-Keuls test for non-paired groups. Significance was defined as p<0.05.

Results

Stimulation of EVT Outgrowth and Migration by Antibody and Antisense Oligonucleotides to Endoglin

The morphological examination of villous explants of 5-8 weeks gestation, cultured in serum-free medium, revealed a pattern of EVT differentiation (cell outgrowth and migration) similar to that described by Genbacev et al (21). The viability of the explants, as measured by the rate of production of progesterone and hCG, remained relatively constant for up to 6 days.

The ability of an antibody to endoglin (MAb 44G4) to alter the early events of EVT differentiation along the invasive pathway was examined. Exposure of villous explants of 5-8 weeks gestation to 44G4 IgG was associated with an increase in EVT outgrowth from the distal end of the villous tips and a higher number of cells migrating into the surrounding matrix. Stimulation of EVT outgrowth and migration by 44G4 IgG was specific as incubation of explants with an equivalent amount of non-immune murine IgG or medium alone had no effect. Furthermore addition of 44D7 IgG (10 μg/ml) reactive with CD98 antigen expressed at high levels on syncytiotrophoblast (26) had no stimulatory effect.

Antisense endoglin also enhanced the number of EVT outgrowths as well as their migration and invasion into the Matrigel. Control explants, cultured in the presence of sense endoglin oligonucleotides, exhibited no such effect.

Further experiments demonstrated that 24 h after the addition of 44G4 IgG (day 2 of culture) there was a significant increase in EVT outgrowth and migration from 0.20±0.03 in the control group to 2.03±0.46 in the antibody treated group (n=4; p<0.005). After 5 days of treatment (day 6) the number of EVT outgrowths increased from 0.64±0.09 in control IgG-treated explants to 3.2±0.5 in the 44G4 IgG-treated explants (n=10, p<0.05). Subsequent experiments demonstrated that the stimulatory effect of 44G4 IgG was dose-dependent and maximal at 1 μg/ml.

The stimulatory effect of antisense endoglin oligonucleotides on EVT outgrowth and migration was observed on day 3 of culture with 6.87±1.5 in the antisense-treated group versus 1.42±0.41 in the sense-treated group (p<0.05). After 5 days of exposure, the number of EVT/villous tip increased from 2.08±0.47 in sense-treated explants to 8.46±1.7 in antisense-treated cultures. The antisense-endoglin effect on trophoblast differentiation was specific as incubation of explants with an equivalent amount of either sense endoglin or scrambled antisense-endoglin oligonucleotide (not shown) had no effect. Antisense endoglin stimulated EVT outgrowth and migration in a concentration-dependent manner with maximal stimulation observed at 10 μM.

Characterization of Trophoblast Differentiation Along the Invasive Pathway in Villous Explants Culture

Previous reports indicate that stem trophoblasts within the villous core and at the proximal site of the column, where trophoblasts start to migrate away from the stem villi, undergo proliferation (21), whereas differentiated EVT do not. Therefore, studies were carried out to determine if EVT outgrowth triggered by antisense endoglin treatment was due to cell division or migration. [³H]Thymidine autoradiography of explants exposed to antisense endoglin ON showed villous trophoblast proliferation within the villous tip at the proximal site of the forming column, while both differentiated EVT, which have invaded the surrounding Matrigel® reagent, and mesenchymal cells in the villous core did not show any DNA synthesis. This suggests that EVT within the column do not divide and that blockage of endoglin most likely induces cell migration from the villous core.

Trophoblast differentiation in situ is accompanied by a temporally and spatially regulated switch in integrin repertoire (4). When placental explants of 5-8 weeks gestation were maintained in culture for 5 days in the presence of antisense-endoglin oligonucleotides, the stimulation of EVT outgrowth and migration was also accompanied by changes in integrin expression. The α₆ integrin subunit was found on polarized cytotrophoblasts within the villi and on the non-polarized trophoblasts in the proximal columns. The α₅ integrin subunit was minimally expressed on polarized trophoblasts or syncytium, but was present on EVT within the columns. EVT which had migrated further away in the Matrigel were negative for the α₅ integrin. All trophoblast cells, including CTB within the villi, the syncytiotrophoblast and EVT stained positively for cytokeratin confirming the epithelial-like nature of the cells forming the columns and migrating into the Matrigel. EVT which have migrated into Matrigel were positive for the α₁ integrin. A polyclonal antibody to TGF-β showed staining of the syncytiotrophoblast and stroma of the villi, suggesting that TGF-β₃ was present in the culture system. Migrating EVT and the Matrigel itself, known to contain TGF-13, showed weak positive staining. No reactivity was observed in the explants stained with control IgG.

As little EVT outgrowth is observed under basal culture conditions, the expression of endoglin in trophoblast columns could only be studied in antisense-treated explants. Immunohistochemical analysis of explants treated with antisense oligonucleotides to endoglin revealed that in intact villi the syncytiophoblast maintained high levels of endoglin. Low levels of endoglin and α₅ integrin were observed in the stroma; however this staining appears non-specific as it was also observed with non-immune IgG. The staining of endoglin in EVT of explants treated with antisense endoglin was weakly positive when compared to sections of the same explant stained with control IgG. In addition, endoglin expression in proximal columns of explants was much reduced when compared to sections of 9 weeks gestation placenta stained under similar conditions. When a subsequent section of this placenta is stained for α₅ integrin, the transition zone in the proximal column is clearly visualized as negative for α₅, but positive for endoglin. The α₅ integrin in explants treated with antisense endoglin was also found to be highly expressed in EVT within proximal and distal columns. These data suggest that antisense endoglin treatment, which promotes EVT outgrowth and migration in explant cultures, induces a decrease in endoglin expression at the level of the transition zone, which is followed by an increase in the expression of the α₅ integrin fibronectin receptor.

Stimulation of Fibronectin Production by Interference with TGF-β Response

FN has been localized to specific regions of the matrix surrounding the anchoring villi and its production is increased during EVT differentiation (27). Thus the effect of either 44G4 IgG or antisense endoglin on fibronectin synthesis by villous explants from 5-8 weeks gestation was investigated. Explants were metabolically labelled on day 4 with [³⁵S]methionine and newly synthesized FN released into the media over a period of 18 h was measured. Both 44G4 IgG and antisense-endoglin oligonucleotides induced a significantly greater production of FN than that observed in control IgG or sense oligonucleotide-treated cultures. PhosphoImager™ instrument analysis of all data demonstrated an 8- and 5-fold increase in FN synthesis (5 independent experiments carried out in triplicate, p<0.05) for 44G4 IgG and antisense-endoglin treated explants, respectively, relative to control sense or DMEM/F12 alone. FN production in villous explants, cultured in the presence of a scrambled antisense endoglin oligonucleotide, was similar to that observed in sense-treated explants or in medium alone.

To demonstrate that endoglin is an essential component of the receptor complex in mediating the effects of TGF-β₁ and TGF-β₃, villous explants were preincubated with either antisense or antibody to endoglin to trigger EVT differentiation. After an overnight incubation, exogenous TGF-β₁, TGF-β₂ or TGF-β₃ were added at a concentration of 10 ng/ml. Explants were metabolically labelled at day 5 of culture and FN synthesis was measured. PhosphoImager™ instrument analysis demonstrated that both antibody and antisense to endoglin significantly stimulated FN synthesis. Addition of exogenous TGF-β₁ and TGF-β₃ to explant cultures incubated with antisense ON or antibody to endoglin, which binds both isoforms, did not alter the stimulatory effect of antisense ON and antibody to endoglin on FN synthesis. In contrast, addition of TGF-β₂, which does not interact with endoglin, overcame the antibody and antisense ON stimulatory effect on FN synthesis. TGF-β₂, but not -β₁ and -β₃, inhibited also the EVT outgrowth and migration induced by the antisense endoglin treatment

Discussion

Treatment of human villous explants from 5-8 weeks gestation with antibodies and antisense oligonucleotides to endoglin stimulated EVT differentiation along the invasive pathway. This was manifested by 1) a significant increase in EVT outgrowth and migration, 2) an increase in fibronectin production 3) stem villous trophoblast proliferation and 4) a switch in integrin expression similar to that observed in vivo during formation of anchoring villi. These data suggest that endoglin regulates EVT differentiation during placental development. Endoglin, which is expressed in vivo in the transition area where polarized trophoblasts break through the syncytium and begin forming columns of non-polarized cells, appears to be a key molecule in mediating the inhibition of trophoblast differentiation.

During the first trimester of gestation TGF-β is colocalized with one of its natural inhibitors, decorin, in the ECM of decidual tissue, suggesting that this proteoglycan may aid TGF-β storage or limit its activity within the decidual ECM (12). The findings described herein suggest that TGF-β₃ produced by the villi is a negative regulator of trophoblast differentiation along the invasive pathway. The expression of endoglin at the transitional zone from polarized to non-polarized trophoblasts appears essential to the mediation of this negative regulation. Blocking endoglin expression in this transition phase triggers EVT outgrowth and migration and FN production. Thus, trophoblast invasion, characteristic of normal human placentation, is dependent on an intricate balance between positive and negative regulators. The data herein indicate that endoglin is a critical negative regulator of this system. Therefore, inappropriate expression or function of endoglin may contribute to the major complications of pregnancy such as preeclampsia or choriocarcinoma, associated with abnormal trophoblast invasion and placenta development.

EXAMPLE 2

The present experiments were conducted to define the precise components that endogenously regulate trophoblast invasion. Using human villous explants of 5-7 weeks gestation it was observed that while trophoblast cells remain viable they do not spontaneously invade into the surrounding matrigel. In contrast, trophoblast cells from 9-13 weeks explants spontaneously invade the matrigel in association with an upregulation of fibronectin synthesis and integrin switching. Trophoblast invasion at 5-7 weeks can be induced by incubation with antisense to TGF-β₃, TGFβ receptor I (ALK-1) or TGFβ receptor II. Only minimal invasion occurred in response to antisense to TGFβ₁ and antisense TGFβ₂ failed to induce invasion. These data suggest that TGF-β₃ via the ALK-1-receptor II complex is a major regulator of trophoblast invasion in vitro. To determine whether this system may also operate in vivo, immunohistochemical staining was conducted for TGF-β1 and -3 and for TGFβ receptor I and II in trophoblast tissue from 5-13 weeks of gestation. Strong positive immunoreactivity was observed for TGF-β₃ in both cyto- and syncytiotrophoblast from 5-9 weeks of gestation but immunoreactivity was markedly reduced by 12-13 weeks. Expression of TGF-β₁ was absent at 5 weeks, and transiently expressed at around 8 weeks of gestation. TGF receptor I and II immunoreactivity was strong between 5-8 weeks but was not present at 12-13 weeks. Thus, the presence of TGF-β₃ and its receptors at 5-8 weeks at a time when there is no spontaneous trophoblast invasion in vitro and the absence of these molecules at 12-13 weeks when spontaneous in vitro invasion occurs is consistent with a major role for TGF-β₃ as an endogenous inhibitor of trophoblast invasion.

EXAMPLE 3

Studies were carried out to determine if shallow trophoblast invasion in preeclampsia was associated with an abnormally sustained inhibition of invasion by TGF-β. In particular, the expression/distribution of the different TGF-β isoforms and their receptors was investigated using immunohistochemical analysis in normal placentae at 7-9 weeks (at the onset of trophoblast invasion) at 12-13 weeks (the period of peak invasion), in control placentae between 29 and 34 weeks and in preeclamptic placentae ranging from 27 to 34 weeks. In normal placentae, TGF-β₃ expression was markedly reduced with advancing gestational age. Expression was high in cyto- and syncytiotrophoblast cells at 7-9 weeks of gestation but was absent in villous tissue at 12-13 weeks and at 29-34 weeks of gestation. A similar decline in positive immunoreactivity against TGF-β receptor I and II was also observed over this time period. In contrast, in preeclamptic placentae between 27-34 weeks of gestation, strong staining for TGF-β₃ and its receptors was present in syncytiotrophoblast and stromal cells. Immunopositive reactivity was not detected against TGF-β₁ or TGF-β₂ in either normal or preeclamptic placentae. These data indicates that preeclampsia may result from a failure of trophoblast cells to downregulate expression of TGF-β₃ and its receptors which continue to exert an inhibitory influence on trophoblast invasion into the uterine wall.

EXAMPLE 4

Materials and Methods

RT-PCR and Southern Blot Analysis

Total RNA was extracted from the placenta, reverse transcribed and amplified by 15 cycles of PCR using TGFβ isoform specific primers. RT-PCR products were analysed by Southern blotting using ³²P-labelled TGFβ cDNAs. The primer set chosen for amplification of TGFβs were based on human mRNA sequences. Primers used for amplification were: (a) TGF-β₁ cDNA: (forward primer): 5′-GCCCTGGACACCAACTATTGCT-3′ (SEQ ID NO: 6), (reversed primer): 5′-AGGCTCCAAATGTAGGGGCAGG-3′ (SEQ ID NO: 7) (predicted product size=161 bp); (b) TGF-β₂ cDNA (forward primer): 5′-CATCTGGTCCCGGTGGCGCT-3′ (SEQ ID NO: 8), (reversed primer): 5′-GACGATTCTGAAGTAGGG-3′ (SEQ ID NO: 9) (predicted product size=353 bp); (c) TGF-β₃ cDNA: (forward primer): 5′-CAAAGGGCTCTGGTGGTCCTG-3′, (SEQ ID NO: 10) (reversed primer): 5′-CTTAGAGGTAATTCCCTTGGGG-3′ (SEQ ID NO: 11) (predicted product size=374 bp); (c) 13-actin cDNA: (forward primer): 5′-CTTCTACAATGAGCTGGGTG-3′, (SEQ ID NO: 12) (reversed primer): 5′-TCATGAGGTAGTCAGTCAGG-3′ (SEQ ID NO: 13) (predicted product size=307 bp). The identity of the PCR reaction products was also confirmed by sequencing.

Immunohistochemistry

Placental tissue was processed for immunocytochemistry as previously described (I. Caniggia et al., Endocrinology. 138, 3976 1997). Purified rabbit polyclonal antibody directed against TGF-β₁, TGF-β₂ and TGF-β₃ (Santa Cruz Biotechnology, Santa Cruz, Calif.) were used at 1:50 dilution. Sections (7 μm) were stained using the avidin-biotin immunoperoxidase method (I. Caniggia et al., Endocrinology. 138, 3976 1997). Control experiments included replacement of primary antibodies with antiserum preincubated with an excess of TGFβs (competing peptide) or with blocking solution [5% (vol/vol) NGS and 1% (wt/vol) BSA].

Human Villus Explant Culture System

Villous explant cultures were established as described previously (I. Caniggia et al Endocrinology. 138, 3976 1997, O. Genbacev et al., Placenta 13:439, 1992) from first trimester human placentae (5-10 weeks gestation) or from preeclamptic and age-matched control placentae (30 and 32 weeks of gestation) after collection according to ethical guidelines. The preeclamptic group was selected according to both clinical and pathological criteria (L. Chesley, Obstet. Gynecol. 65, 423, 1985). Following an overnight period in serum-free DMEM/F12, explants were cultured in media containing antisense or sense oligonucleotides (10 μM) for up to 6 days (with changes of media/oligonucleotides every 48 hours). Phosphorothioate oligonucleotides of 16 base pairs targeted against sequences adjacent to the AUG initiation codon of different human TGFβ isoforms mRNA were synthesized as follows: TGF-β₁ 5′-CCCCGAGGGCGGCATG-3′ (SEQ ID NO: 14) and 5′-CATGCCGCCCTCGGGG-3′, (SEQ ID NO: 15) respectively; TGFβ₂ 5′-CACACAGTAGTGCATG-3′ (SEQ ID NO: 16) and 5′-CATGCACTACTGTGTG-3′ (SEQ ID NO: 17); TGF-β₃ 5′-CCTTTGCAAGTGCATC-3′ (SEQ ID NO: 1) and 5′-GATGCACTTGCAAAGG-3′ (SEQ ID NO: 2).

Fibronectin Synthesis

To measure fibronectin synthesis on day 5 explants were cultured in the presence of 25 μCi/ml of [³⁵S]methionine/cysteine for 18 hours. Conditioned culture media were collected and diluted with an equal amount of 25 mM Tris-HCl buffer, pH 7.4, 0.15 M NaCl and 0.5% (v/v) Triton® X-100 reagent and fibronectin was isolated using gelatin-Sepharose® reagent as previously described (I. Caniggia et al Endocrinology. 138, 3976 1997, E. Engvall et al Int. J. Cancer. 20:1, 1977). Radiolabeled fibronectin was revealed by autoradiography and quantitated using a PhosphoImager™ instrument (410A and Image Quant software, Molecular Dynamics).

Gelatinolytic Activity

Analysis of gelatinolytic activity was performed using 10% polyacrylamide gel (wt/vol) impregnated with 0.1% gelatin (NOVEX, San Diego, Calif.) as previously described (I. Caniggia et al Endocrinology. 138, 3976 1997). For Western blot analysis of metalloproteases expression, 5 μl of conditioned media were subjected to gel electrophoresis using 10% polyacrylamide gels. Proteins were then blotted to Westran® PVDF membrane. Primary antibodies were used at 1:100 dilution and detected using horse radish peroxidase conjugated antimouse IgG (Amersham 1:10.000 fold dilution) and enhanced by chemiluminescence (ECL, Amersham).

Results:

The expression of TGFβ around 9-12 weeks of pregnancy and its relationship to trophoblast invasion and subsequently preeclampsia were investigated. Using low cycle RT-PCR followed by Southern blot analysis all three isoforms of TGFβ were found to be expressed during the first trimester (FIG. 3A). However, while transcripts corresponding to TGF-β₁ and TGF-β₂ were uniformly expressed throughout this period, the expression of TGF-β₃ exhibited a striking pattern of developmental or temporal regulation. TGF-β₃ mRNA levels were relatively low at 5-6 weeks, increased markedly between 7 and 8 weeks, and then fell precipitously at 9 weeks. This pattern of expression for the TGF-β₃ isoform was confirmed at the protein level by immunohistochemistry (FIG. 3B). TGF-β₃ was localized to cyto and syncytiotrophoblasts within the villous and also to cytotrophoblasts within the invading column (FIG. 3B). TGF-β₃ was noticeably absent in those cytotrophoblast cells at the transition between polarized and non-polarized cells at the proximal site of the forming column. Importantly, the down-regulation of TGF-β₃ around 9 weeks is temporally associated with the period of maximal trophoblast invasion in vivo and the expression of markers of cytotrophoblast invasion, including switching of integrin isoforms (Damsky, C. H. et al Development 120:3657, 1994), synthesis of matrix ligands for these integrins (P. Bischof, L. Haenggeli A. Campana, Human Reprod. 10, 734. (1995), M. J. Kupferminc, A. M. Peaceman, T. R. Wigton, K. A. Rehnberg, M. A. Socol, Am. J. Obstet. Gynecol. 172, 649 (1995)) and upregulation of gelatinase A (MMP2) and gelatinase B (MMP9) activity (C. I. Librach, et al. J. Biol. Chem. 269, 17125. (1994)).

To determine the functional significance of the TGFβ expression patterns, a human villous explant culture system was used which mimics closely the normal pattern of trophoblast invasion in vivo (I. Caniggia, C. V. Taylor, J. W. K. Ritchie, S. J. Lye, M. Letarte, Endocrinology. 138, 4977 (1997), O. Genbacev, S. A. Schubach, R. K. Miller, Placenta 13, 439. (1992)). Morphologic (EVT outgrowth) and biochemical (fibronectin [FN] synthesis and gelatinase activity) indices of trophoblast invasion were monitored in response to antisense (AS) induced suppression of TGFβ isoform expression in explants at 5-8 weeks of gestation. Explants exposed to AS TGF-β₃ (but not TGFβ₁ or TGFβ₂) displayed prominent EVT outgrowth from the distal end of the villous tip (FIG. 4A). This morphologic response was associated with a significant increase in FN synthesis (FIG. 4B, and FIG. 4E) and gelatinase activity (FIG. 4D). The specificity of the AS TGF-β₃ response was demonstrated by reversal of both morphologic and biochemical indices when AS-treated explants were cultured in the presence of TGF-β₃ but not TGFβ₁ (FIG. 4C). The induction of FN synthesis by AS TGF-β₃ at 5-8 weeks was lost at 9-13 weeks (FIG. 4E) further demonstrating the specificity of the AS action as TGF-β₃ is not expressed in villous trophoblast at 9-12 weeks.

These functional data together with the temporal-spatial expression patterns strongly suggest that down-regulation of TGF-β₃ around 9-12 weeks is required for optimal trophoblast invasion indicate that a failure to down-regulate TGF-β₃ expression is the basis of limited trophoblast invasion found in preeclampsia. Significantly higher levels of mRNA encoding TGF-β₃ (but not TGFβ₁ or TGFβ₂) were found in preeclamptic versus control placentae (FIG. 5A). Immunoreactive TGF-β₃ intensively labelled syncytio and cytotrophoblasts in villous tissues from preeclamptic patients while little or no immunoreactivity was present in the age-matched controls (FIG. 5B). Elevated levels of FN mRNA and a failure to complete integrin switching (i.e., the trophoblast remain positive for α₅ and fail to express α₁ were also observed in preeclamptic placentae. These data suggest that the trophoblasts from preeclamptic placenta are arrested at a relatively immature phenotype possibly due to a failure to undergo complete differentiation along the invasive pathway during the first trimester of gestation.

To determine whether there was functional significance associated with overexpression of TGF-β₃ in preeclamptic placentae, the pattern of trophoblast differentiation along the invasive pathway in explants from control and preeclamptic patients was analyzed. When cultured on matrigel, explants from non-preeclamptic patients showed formation of EVT columns which spontaneously invaded into the surrounding matrigel. In contrast, explants from preeclamptic placentae failed to exhibit EVT outgrowth or invasion (FIG. 6A). These data are consistent with the view that preeclampsia is associated with reduced invasive capability of trophoblasts. Of critical importance to the investigation was whether this reduced invasive capability was due to the overexpression of TGF-β₃. Therefore the differentiation of villous explants from preeclamptic patients cultured in the presence of AS TGF-β₃ was monitored. In contrast to untreated or sense-treated controls, treatment of explants from preeclamptic patients with AS TGF-β₃ restored the invasive capability, as demonstrated by the formation of EVT columns migrating through the matrigel (FIG. 6A). The invasive nature of this phenotype was confirmed by the finding that explants treated with AS TGF-β₃ acquired the expression of gelatinase B/MMP9, an enzyme which is normally only expressed in trophoblast cells that are highly invasive (FIG. 6B and FIG. 6C).

The data presented here demonstrate not only that abnormalities in TGF-β₃ expression are associated with preeclampsia but also that down-regulation of TGF-β₃ with antisense oligonucleotides restores the invasive capability of preeclamptic trophoblasts. The data are consistent with a model of normal placentation in which down-regulation of TGF-β₃ expression in trophoblast around 9 weeks of pregnancy permits differentiation of trophoblast to EVT that form the anchoring villi and from which derive the α1-integrin positive EVT which invade deep into the maternal uterus. This invasion contributes to the remodelling of the uterine spiral arteries and ultimately enables the establishment of increased vascular perfusion of the placenta. In placentae predisposed to preeclampsia, TGF-β₃ expression remains abnormally elevated and trophoblasts remain in a relatively immature state of differentiation. As a direct consequence, trophoblast invasion into the uterus is limited and uteroplacental perfusion is reduced. This conclusion is consistent with the clinical manifestations of preeclampsia, including shallow trophoblast invasion into the uterus and abnormally high uteroplacental vascular resistance.

EXAMPLE 5

Role of O₂ Tension in Trophoblast Invasion

The role of oxygen tension in regulating trophoblast differentiation along the invasive pathway has been investigated. The data indicate that expression of hypoxia inducible factor HIF-1α parallels that of TGF-β₃ in first trimester trophoblast (i.e. peaks at 6-8 weeks but decreases after 9-10 weeks when oxygen tension increases (FIG. 7A). The presence of putative HIF-1 binding sites in the promoter region of the TGF-β₃ gene suggests that induction of HIF-1α by low PO₂ (around 6-8 weeks) up regulates TGF-β₃ transcription and blocks a trophoblast invasion. A failure of the system to down-regulate at 9-12 weeks (either due to a block in response to normoxia or the absence of an increase in oxygen tension) could lead to shallow invasion and predispose to preeclampsia. This is supported by data showing that expression of HIF-1α is dramatically increased in placentas of preeclamptic patients when compared to age-matched control tissue (FIG. 7B). In FIGS. 7A and 7B mRNA HIF-1α expression was assessed by using low cycle RT-PCR followed by Southern blot analysis. This is also supported by FIG. 8 showing the effect of low oxygen tension of TGF-β₃ and HIF-1α expression in villous explants; FIG. 9 showing the effect of low oxygen tension on villous explant morphology; and FIG. 10 showing the effect of antisense to HIF-1α on villous explant morphology.

EXAMPLE 6

TGF-β₃ Signals through a Receptor Complex

In addition to endoglin, evidence indicates that TGF-β₃ signals through a receptor complex which includes RI (ALK-1) and RII. While TGFβ R-I (ALK-5) and TGFβ R-II are expressed throughout the villi and decidua at 9-10 weeks gestation; they are absent from the base of the proximal columns of the anchoring villi at the transition zone between the villous and the invading EVT, exactly at the site where endoglin is unregulated. This dramatic change in TGF-β receptor expression suggests that EVTs within the columns in situ are not subject to the inhibitory actions of TGFβ but via R-I and R-II they do come under the control of this ligand upon entering the decidua. The potential clinical importance of the TGFβ receptor system in trophoblast invasion is highlighted by data demonstrating that beside TGF-β₃, R-I is expressed at greater levels in trophoblast tissue of preeclamptic patients when compared to that in age-matched control placenta. Antisense disruption of R-I (ALK-1) and R-II expression stimulated trophoblast outgrowth/migration and FN synthesis. In contrast, antisense to R-I (ALK-5) inhibited FN synthesis.

While the present invention has been described with reference to what are presently considered to be the preferred examples, it is to be understood that the invention is not limited to the disclosed examples. To the contrary, the invention is intended to cover various modifications and equivalent arrangements included within the spirit and scope of the appended claims.

All publications, patents and patent applications are herein incorporated by reference in their entirety to the same extent as if each individual publication, patent or patent application was specifically and individually indicated to be incorporated by reference in its entirety.

Below full citations are set out for the references referred to in the specification and detailed legends for the figures are provided.

FULL CITATIONS FOR REFERENCES REFERRED TO IN THE SPECIFICATION

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Endoglin is a     component of the TGF-b receptor complex of human pre-B leukemic     cells. J. Immunol. 156: 565-573. -   20. Lastres P, Letamendia A, Zhang H, et al. 1996. Endoglin     modulates cellular responses to TGF-b1. J. Cell Biol. 133:     1109-1121. -   21. Genbacev O, Schubach S A, Miller R K. (1992). Villous culture of     first trimester human placenta-Model to study extravillous     trophoblast (EVT) differentiation. Placenta. 13: 439-461. -   22. Quackenbush E J and Letarte M. 1985. Identification of several     cell surface proteins of non-T, non-B acute lymphoblastic leukemia     by using monoclonal antibodies. J. Immunol. 134: 1276-1285. -   23. Gougos A, and Letarte M. 1990. Primary structure of endoglin, an     RGD-containing glycoprotein of human endothelial cells. J. Biol.     Chem. 265: 8361-8364. -   24. Malcolm A D B. 1992. Uses and applications of antisense     oligonucleotides: uses of antisense nucleic acids-an introduction.     Bioch. Soc. Trans. 20: 745-746. -   25. Engvall E, and Ruoslahti E. 1977. Binding of soluble form of     fibroblast surface protein, fibronectin, to collagen. Int. J.     Cancer. 20:1-5. -   26. Soubiran P, Hsi B-L, Lipinski M, Yeh C-J G, Vaigot P,     Masseyeff R. 1986. Distribution of Trop 3 and 4 antigens as defined     by monoclonal antibodies raised against a human choriocarcinoma cell     line. A.J.R.I.M. 12: 118-123. -   27. Feinberg R F, Kilman H J, Locwood C J. 1991 Is oncofetal     fibronectin a trophoblast glue for human implantation? Am. J.     Pathol. 138: 537-543. -   28. Vicovac I, Jones C J, Aplin J D. 1995. Trophoblast     differentiation during formation of anchoring villi in a model of     the early human placenta in vitro. Placenta. 16: 41-56. -   29. Feinberg R F, Kliman H J, Wang C-L. 1994. Transforming growth     factor-b stimulates trophoblast oncofetal fibronectin synthesis in     vitro: implications for trophoblast implantation in vivo. J. Clin.     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DETAILED FIGURE LEGENDS

-   FIG. 3 Expression of TGF-β isoforms in human placenta in the first     trimester of gestation. (FIG. 3A) Message expression of TGFβ     isoforms was assessed by low cycle RT-PCR followed by Southern blot     analysis using specific probes for TGF-β₁, TGF-β₂ and TGF-β₃ and the     control house-keeping gene β-actin. Note that TGF-β₃ expression     increases around 7-8 weeks gestation and declines thereafter. (FIG.     3B) Immunoperoxidase staining of TGF-β₃ was performed in placental     sections at 5, 8 and 12 weeks of gestation. Sections of placental     tissue of 5 weeks gestation show positive immunoreactivity     visualized by brown staining in the cytotrophoblast,     syncytiotrophoblast and stromal cells of the chorionic villi.     Sections of placental tissue of 8 weeks gestation show strong     positive immunoreactivity in the cytotrophoblast,     syncytiotrophoblast, and stromal cells. Note that TGF-β₃ was     expressed in the non-polarized trophoblast within the column (EVT,     thin arrow) but was absent in the transitional zone where polarized     cells become unpolarized (thick arrows). Sections of placenta at 12     weeks gestation demonstrate low or absent TGF-β₃ immunoreactivity in     the villi. There is no immunoreactivity when antiserum was     preincubated with an excess of TGF-β₃ competing peptide (8 weeks,     control). -   FIG. 4 Antisense TGF-β₃ stimulates trophoblast migration,     fibronectin production and gelatinase activity. Explants of 5-8     weeks gestation were treated for 5 days with 10 μM antisense     oligonucleotides to TGF-β₃ (AS-β3), AS-β3 plus 10 ng/ml recombinant     TGF-β₃ (AS-β3+β3) or AS-β3 plus recombinant TGF-β₁ (AS-β3+β1).     Control experiments were run in parallel using sense TGF-β₃ (S-β3)     or medium alone (FIG. 4C). (FIG. 4A) Shown is a representative     experiment demonstrating that addition of recombinant TGF-β₃ to     antisense TGF-β₃ treated explants (AS-β3+β3) abolishes the antisense     stimulatory effect on trophoblasts budding and outgrowth (arrows).     (FIG. 4B) Similar reversal effect on AS-β3 stimulatory effect by     exogenous TGF-β₃ was demonstrated also for fibronectin synthesis.     Representative analysis of triplicate samples from a single     experiment is shown. The position of the marker with M_(r)=200×10³     is indicated. Lanes 1-3, S-β3 treated explants; lanes 4-6, AS-β3     treated explants; lanes 7-9, AS-β3+β3 treated explants. (FIG. 4C)     Changes in fibronectin estimated after normalization to control     cultures. Antisense TGF-β₃ treatment (AS-β3, solid bar)     significantly increased (p<0.05; one-way ANOVA followed by     Student-Newman-Keuls test for non-paired groups) the amount of     labelled fibronectin compared to both medium alone (FIG. 4C, open     bar) or sense (S-β3, cross bar). Addition of exogenous TGF-β₃     (AS-β3+β3 squares bar) but not TGF-β₁ (AS-β3+β1 cross hatched bar)     to the antisense treated explants abolished the antisense     stimulatory effect on fibronectin production demonstrating the     specificity of the action of TGF-β₃. (FIG. 4D) Gelatinase activity     in conditioned media of explants treated with sense or antisense     oligonucleotides to TGF-β3. Arrows indicate positions of gelatinases     activity (MMP2: 60, 68; MMP9: 84 and 92, kDa). (FIG. 4E) The     antisense TGF-β₃ stimulatory effect on fibronectin production is     lost after 9 weeks of gestation. Explants of 6 and 10 weeks     gestation were treated with 10 μM antisense (AS-β3) or control sense     (S-β3) oligonucleotides to TGF-β₃. Newly synthesized fibronectin was     isolated from the medium as described above. Representative analysis     of triplicate samples from a single experiment is shown. Lanes 1-3     and 7-9, S-β3 treated explants; lanes 4-6 and 10-12, AS-β3 treated     explants. -   FIG. 5 TGF-β₃ is overexpressed in preeclamptic placentae. (FIG. 5A)     Message expression of TGFβ isoforms, α₅ integrin receptor and     fibronectin in preeclamptic (PE) and age-matched control placentae     (FIG. 5C) was assessed by low cycle RT-PCR followed by Southern blot     analysis using specific probes for TGF-β₁, TGF-β₂, TGF-β₃, α₅,     fibronectin and the control house-keeping gene β-actin. Note that     TGF-β₃, α₅ and fibronectin, but not TGF-β₁ or TGF-β₂, expression     were higher in preeclamptic placentae when compared to age-matched     control. (FIG. 5B) Immunoperoxidase staining of TGF-β₃ was performed     in placental sections from normal pregnancies and pregnancies     complicated by preeclampsia. Sections of normal placental tissue of     29, 31 and 33 weeks of gestation show low/absent TGF-β₃     immunoreactivity in cells of the chorionic villi. Sections of     preeclamptic placental tissue of the same gestation show strong     positive immunoreactivity visualized by brown staining in the     cytotrophoblast, syncytiotrophoblast and stromal cells of the     chorionic villi. Control experiments were performed using antiserum     preabsorbed with an excess of peptide. -   FIG. 6A Antisense oligonucleotides to TGF-β₃ induce the formation of     columns of trophoblast cells in preeclamptic villous explants.     Villous explant cultures were prepared from preeclamptic and     age-matched control placentae. Explants were maintained in culture     in the presence of either control sense or antisense     oligonucleotides to TGF-β₃ for 5 days. Morphological integrity was     recorded daily. Explants from normal placenta (32 weeks), exposed to     sense oligonucleotides (S-β3) spontaneously form columns of     trophoblast cells which migrate and invade into the surrounding     Matrigel (arrows), while explants from preeclamptic placenta (32     weeks) exposed to sense oligonucleotides do not. In contrast,     antisense treatment (AS-β3) triggers the formation of invading     trophoblast columns (arrows) in preeclamptic placentae.

FIG. 6B and FIG. 6C. Antisense oligonucleotides to TGF-β₃ triggers gelatinase activity and expression in preeclamptic villous explants. Explants of 32 weeks gestation from preeclamptic placentae were treated with antisense (AS-β3) or control sense (S-β3) oligonucleotides to TGF-β₃ for 5 days. Samples of conditioned medium were collected at day 5 and subjected to analysis by gelatin Zymography (FIG. 6B) or Western blotting with MMP9 antisera (FIG. 6C). Arrows indicate positions of gelatinases activity (MMP-2: 60, 68; MMP-9: 84 and 92, kDa). 

1. A method for diagnosing an increased risk of preeclampsia in a subject, the method comprising a) detecting a level of HIF-1α in a fluid sample from the subject; and b) comparing the level detected in the subject's fluid sample to a control level obtained from samples of the same fluid taken at the same time of pregnancy from women who did not develop preeclampsia; wherein an increased level of HIF-1α in the fluid sample from the subject over that of a control level obtained from samples of the same fluid taken at the same time of pregnancy from women who did not develop preeclampsia indicates an increased risk of preeclampsia.
 2. A method for diagnosing or identifying an increased risk of preeclampsia in a subject, the method comprising: a) contacting a fluid sample from a subject at a first time in pregnancy with a diagnostic reagent that measures a first level of HIF-1α; and b) diagnosing or identifying an increased risk of preeclampsia in the subject based upon an increased level of HIF-1α in the fluid sample from the subject over that of (i) a first control level of HIF-1α obtained from samples of the same fluid taken at the same time of pregnancy from women who did not develop preeclampsia; or (ii) an earlier sample level of HIF-1α obtained from samples of the same fluid taken from the same subject at an earlier time in the pregnancy.
 3. A method according to claim 2, wherein the levels of HIF-1α are measured by detecting, directly or indirectly, the interaction of the HIF-1α with an antibody specific for HIF-1α.
 4. A method according to claim 3, wherein the antibody is labeled with an enzyme, fluorescent, luminescent or radioactive material.
 5. A method according to claim 3, further comprising performing a step selected from the group consisting of a counter immuno-electrophoresis, a radioimmunoassay, radioimmunoprecipitation assay, an enzyme-linked immunosorbent assay, a dot blot assay or an inhibition of competition assay and a sandwich assay using said antibody.
 6. A method according to claim 2, wherein the fluid sample of (a) is obtained at greater than 9 weeks of pregnancy.
 7. A method according to claim 6, wherein the subject does not have an increased risk of developing preeclampsia if the first level is the same as either the first control level or the earlier sample level.
 8. A method according to claim 2, wherein the first time of pregnancy is 12 to 13 weeks of pregnancy.
 9. A method according to claim 2, wherein the first time of pregnancy is 27 to 34 weeks of pregnancy.
 10. A method according to claim 2, wherein said contacting comprises forming a complex in said first fluid sample comprising an antibody specific for HIF-1α and HIF-1α in the sample.
 11. A method according to claim 10, wherein said contacting further comprises measuring a level of said complex in a suitable assay.
 12. A method according to claim 2, where steps (a) and (b) are repeated during the subject's pregnancy.
 13. A method according to claim 2, further comprising: c) contacting a fluid sample from the subject at a second time of pregnancy occurring later than step (a) with said diagnostic reagent and measuring a second level of HIF-1α; and d) providing a diagnosis of increased risk of preeclampsia based upon an increase in the second level over (i) the first control level; (ii) the earlier sample level; (iii) the first level of (a); or (iv) a second control level of HIF-1α obtained from samples of the same fluid taken at the same second time of pregnancy from women who did not develop preeclampsia.
 14. A method according to claim 13, wherein the subject has an increased risk of developing preeclampsia if the second level is higher than any of levels (i) through (iv).
 15. A method according to claim 2 wherein levels of HIF-1α are measured by detecting a nucleic acid sequences encoding HIF-1α.
 16. A method according to claim 15 wherein the nucleic acid sequence encoding HIF-1α is detected using a nucleotide probe that hybridizes to the nucleic acid sequence or by selective amplification of the nucleic acid sequence using polymerase chain reaction.
 17. A method for diagnosing or identifying an increased risk of preeclampsia in a subject, the method comprising: a) detecting a level of HIF-1α in a fluid sample from the subject in the first 16 weeks of pregnancy; and b) comparing the level detected in the subject's fluid sample to a control level obtained from samples of the same fluid taken at the same stage of pregnancy from women who did not develop preeclampsia; wherein an increased level of HIF-1α in the fluid sample from the subject indicates the increased risk of preeclampsia.
 18. A method according to claim 17 wherein the levels of HIF-1α are measured by detecting, directly or indirectly, the interaction of the HIF-1α with an antibody specific for HIF-1α.
 19. A method according to claim 18 wherein the antibody is labeled with an enzyme, fluorescent, luminescent or radioactive material.
 20. A method according to claim 18 wherein the antibody is used in counter immuno-electrophoresis, a radioimmunoassay, radioimmunoprecipitation assay, an enzyme-linked immunosorbent assay, a dot blot assay or an inhibition of competition assay or a sandwich assay.
 21. A method according to claim 17 wherein levels of HIF-1α are measured by detecting a nucleic acid sequences encoding HIF-1α.
 22. A method according to claim 21 wherein the nucleic acid sequence encoding HIF-1α is detected using a nucleotide probe that hybridizes to the nucleic acid sequence or by selective amplification of the nucleic acid sequence using polymerase chain reaction. 